Abnormal serum alanine transaminase levels in adult patients with type 1 diabetes

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Abstract Obesity in type 1 diabetes increases the risk of insulin resistance, metabolic syndrome (MetS) and greater susceptibility to fatty liver disease. We evaluated the prevalence of elevated alanine transaminase (ALT) and its likely predictors in patients with type 1 diabetes and also investigated its relationship with MetS. We undertook a retrospective analysis of 215 patients above 18 years of age with type 1 diabetes who attended our diabetes clinics from October 2014 to December 2017. Patients’ anthropometric, clinical, biochemical and radiological data were obtained from the hospital portal. Patients were stratified according to the presence of normal or elevated ALT and as per presence or absence of MetS. In all, 20.5% of patients had raised ALT levels. They had higher systolic and diastolic blood pressure (SBP and DBP; p‐value for both: <0.0001), higher insulin requirement (p<0.007), lower HDL levels (p=0.01) and higher urine albumin excretion (UACR; p=0.004) in comparison to patients with normal ALT. In the raised ALT group, 56.8% had MetS in comparison to 16.4% in the normal ALT group as per WHO criteria. Overall, 57 patients had an ultrasound scan and only 10 patients had fatty liver (seven in the raised ALT group) radiologically. Linear regression showed correlation of ALT with female gender, SBP, DBP, insulin dose, HDL and UACR. In the raised ALT group, the predictors of ALT were gender, BMI and UACR. In conclusion, raised ALT is not uncommon in type 1 diabetes. These patients may often have underlying insulin resistance and higher risk of MetS and therefore should be assessed promptly to establish abnormalities which may be amenable to interventions. Copyright © 2018 John Wiley & Sons.

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